Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform
Abstract Background Socioeconomic differences in receipt of adjuvant treatment contribute to persistent disparities in breast cancer (BCA) outcomes, including survival. Adjuvant endocrine therapy (AET) substantially reduces recurrence risk and is recommended by clinical guidelines for nearly all wom...
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-021-08149-0 |
| _version_ | 1818613400733745152 |
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| author | Kirsten Y. Eom G. J. van Londen Jie Li Bassam Dahman Cathy Bradley Lindsay M. Sabik |
| author_facet | Kirsten Y. Eom G. J. van Londen Jie Li Bassam Dahman Cathy Bradley Lindsay M. Sabik |
| author_sort | Kirsten Y. Eom |
| collection | DOAJ |
| description | Abstract Background Socioeconomic differences in receipt of adjuvant treatment contribute to persistent disparities in breast cancer (BCA) outcomes, including survival. Adjuvant endocrine therapy (AET) substantially reduces recurrence risk and is recommended by clinical guidelines for nearly all women with hormone receptor-positive non-metastatic BCA. However, AET use among uninsured or underinsured populations has been understudied. The health reform implemented by the US state of Massachusetts in 2006 expanded health insurance coverage and increased the scope of benefits for many with coverage. This study examines changes in the initiation of AET among BCA patients in Massachusetts after the health reform. Methods We used Massachusetts Cancer Registry data from 2004 to 2013 for a sample of estrogen receptor (ER)-positive BCA surgical patients aged 20–64 years. We estimated multivariable regression models to assess differential changes in the likelihood initiating AET after Massachusetts health reform by area-level income, comparing women from lower- and higher-income ZIP codes in Massachusetts. Results There was a 5-percentage point (p-value< 0.001) relative increase in the likelihood of initiating AET among BCA patients aged 20–64 years in low-income areas, compared to higher-income areas, after the reform. The increase was more pronounced among younger patients aged 20–49 years (7.1-percentage point increase). Conclusions The expansion of health insurance in Massachusetts was associated with a significant relative increase in the likelihood of AET initiation among women in low-income areas compared with those in high-income areas. Our results suggest that expansions of health insurance coverage and improved access to care can increase the number of eligible patients initiating AET and may ameliorate socioeconomic disparities in BCA outcomes. |
| first_indexed | 2024-12-16T16:01:31Z |
| format | Article |
| id | doaj.art-171b12c951e64068a08d4e1663df2ec3 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-16T16:01:31Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-171b12c951e64068a08d4e1663df2ec32022-12-21T22:25:28ZengBMCBMC Cancer1471-24072021-05-012111910.1186/s12885-021-08149-0Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reformKirsten Y. Eom0G. J. van Londen1Jie Li2Bassam Dahman3Cathy Bradley4Lindsay M. Sabik5Department of Health Policy and Management, University of PittsburghDivisions of Hematology-Oncology and Geriatric Medicine, Department of Medicine, University of PittsburghDepartment of Health Policy and Management, University of PittsburghDepartment of Health Behavior and Policy, Virginia Commonwealth UniversityUniversity of Colorado Comprehensive Cancer CenterDepartment of Health Policy and Management, University of PittsburghAbstract Background Socioeconomic differences in receipt of adjuvant treatment contribute to persistent disparities in breast cancer (BCA) outcomes, including survival. Adjuvant endocrine therapy (AET) substantially reduces recurrence risk and is recommended by clinical guidelines for nearly all women with hormone receptor-positive non-metastatic BCA. However, AET use among uninsured or underinsured populations has been understudied. The health reform implemented by the US state of Massachusetts in 2006 expanded health insurance coverage and increased the scope of benefits for many with coverage. This study examines changes in the initiation of AET among BCA patients in Massachusetts after the health reform. Methods We used Massachusetts Cancer Registry data from 2004 to 2013 for a sample of estrogen receptor (ER)-positive BCA surgical patients aged 20–64 years. We estimated multivariable regression models to assess differential changes in the likelihood initiating AET after Massachusetts health reform by area-level income, comparing women from lower- and higher-income ZIP codes in Massachusetts. Results There was a 5-percentage point (p-value< 0.001) relative increase in the likelihood of initiating AET among BCA patients aged 20–64 years in low-income areas, compared to higher-income areas, after the reform. The increase was more pronounced among younger patients aged 20–49 years (7.1-percentage point increase). Conclusions The expansion of health insurance in Massachusetts was associated with a significant relative increase in the likelihood of AET initiation among women in low-income areas compared with those in high-income areas. Our results suggest that expansions of health insurance coverage and improved access to care can increase the number of eligible patients initiating AET and may ameliorate socioeconomic disparities in BCA outcomes.https://doi.org/10.1186/s12885-021-08149-0Breast cancerAdjuvant endocrine therapyMassachusetts health reformHealth insuranceCancer registry |
| spellingShingle | Kirsten Y. Eom G. J. van Londen Jie Li Bassam Dahman Cathy Bradley Lindsay M. Sabik Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform BMC Cancer Breast cancer Adjuvant endocrine therapy Massachusetts health reform Health insurance Cancer registry |
| title | Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform |
| title_full | Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform |
| title_fullStr | Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform |
| title_full_unstemmed | Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform |
| title_short | Changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform |
| title_sort | changes in initiation of adjuvant endocrine therapy for breast cancer after state health reform |
| topic | Breast cancer Adjuvant endocrine therapy Massachusetts health reform Health insurance Cancer registry |
| url | https://doi.org/10.1186/s12885-021-08149-0 |
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